Key Findings
- A multicenter Phase 3 clinical trial (ROADS) compared cesium-131 collagen tile-based radiation therapy (TBRT) with standard postoperative stereotactic radiation therapy (SRT) in patients with newly diagnosed brain metastases requiring surgical resection.
- At one year, local recurrence at the surgical site was 1.3% in the TBRT group versus 15.4% in the SRT group.
- Median overall survival was 42.5 months with TBRT versus 17.6 months with SRT.
- Rates of serious treatment-related side effects and radiation necrosis were similar between the two groups.
- Patients receiving TBRT completed cranial radiation in a median of 1 day, compared with 32 days for SRT.
Background
Current standard of care for patients with brain metastases requiring surgery is surgical resection followed by stereotactic radiation therapy (SRT) to the cavity, typically delivered within four weeks after surgery. Without radiation, local recurrence rates are 50-60%. Logistical and scheduling challenges lead to about 20% of patients not receiving planned postoperative SRT.
Tile-based brachytherapy (TBRT) uses an FDA-cleared device containing cesium-131 seeds embedded in a collagen matrix. The tiles are placed in the surgical cavity during surgery, delivering low-dose radiation over several weeks while limiting exposure to healthy tissue.
Statements from the Researchers
"Implanting the radioactive tiles at the time of surgery guarantees immediate treatment and focal dose escalation, leading to meaningful impact on local tumor control."
— Jeffrey Weinberg, M.D., Professor of Neurosurgery at MD Anderson
Dr. Weinberg noted the improvement in local control and overall survival is substantial.
"The results are dramatically better than current alternatives and provide improved patient convenience by allowing faster return to systemic cancer treatments."
— Thomas Beckham, M.D., Ph.D., Assistant Professor of CNS Radiation Oncology at MD Anderson
Dr. Beckham noted the positive impact on overall survival was larger than expected.
Implications
Researchers hope the results will accelerate guideline adoption and broader clinical rollout of TBRT. Future work may explore its use for other tumor types.